Advances in minimally invasive surgical technology could dramatically increase the number of surgeries performed in a minimally invasive manner. Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. The average length of a hospital stay for a standard surgery may also be shortened significantly using minimally invasive surgical techniques. Thus, an increased adoption of minimally invasive techniques could save millions of hospital days, and millions of dollars annually in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work may also be reduced with minimally invasive surgery.
The most common form of minimally invasive surgery may be endoscopy. Probably the most common form of endoscopy is laparoscopy, which is minimally invasive inspection and surgery inside the abdominal cavity. In standard laparoscopic surgery, a patient""s abdomen is insufflated with gas, and cannula sleeves are passed through small (approximately xc2xd inch) incisions to provide entry ports for laparoscopic surgical instruments. The laparoscopic surgical instruments generally include a laparoscope (for viewing the surgical field) and working tools. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an extension tube. As used herein, the term xe2x80x9cend effectorxe2x80x9d means the actual working part of the surgical instrument and can include clamps, graspers, scissors, staplers, and needle holders, for example. To perform surgical procedures, the surgeon passes these working tools or instruments through the cannula sleeves to an internal surgical site and manipulates them from outside the abdomen. The surgeon monitors the procedure by means of a monitor that displays an image of the surgical site taken from the laparoscope. Similar endoscopic techniques are employed in, e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy and the like.
There are many disadvantages relating to current minimally invasive surgical (MIS) technology. For example, existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Most current laparoscopic tools have rigid shafts, so that it can be difficult to approach the worksite through the small incision. Additionally, the length and construction of many endoscopic instruments reduces the surgeon""s ability to feel forces exerted by tissues and organs on the end effector of the associated tool. The lack of dexterity and sensitivity of endoscopic tools is a major impediment to the expansion of minimally invasive surgery.
Minimally invasive telesurgical robotic systems are being developed to increase a surgeon""s dexterity when working within an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location. In a telesurgery system, the surgeon is often provided with an image of the surgical site at a computer workstation. While viewing a three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master input or control devices of the workstation. The master controls the motion of a servomechanically operated surgical instrument. During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors such as, e.g., tissue graspers, needle drivers, or the like, that perform various functions for the surgeon, e.g., holding or driving a needle, grasping a blood vessel, or dissecting tissue, or the like, in response to manipulation of the master control devices.
A typical surgery employs a number of different surgical instruments. When a different tool is desired during the surgical procedure, the surgical instrument is typically withdrawn from the surgical site so that it can be removed from its associated arm and replaced with an instrument bearing the desired end effector. The desired surgical instrument is then inserted into the surgical site.
A surgical instrument may also be withdrawn from a surgical site for reasons other than to replace the end effector. For example, the loading of a clip in a clip applier used in affixing tissue typically occurs outside of the patient""s body. Each time a new clip is desired, the clip applier is removed from the surgical site to load the clip and then reintroduced into the patient""s body to apply the clip. Tool exchange and instrument loading for a robotic system takes time. Providing additional surgical instruments in the surgical site (and the typically associated need to make additional incisions in the patient""s body) may be an undesirable alternative for any number of reasons, e.g., due to space constraints, increase in system complexities, and/or cost.
The present invention is generally directed to robotic surgery methods, devices, and systems. The invention overcomes the problems and disadvantages of the prior art by providing surgical clips and/or other in vivo accessories at the surgical site. These in vivo accessories can be manipulated by robotic surgical tools in the site for performing different tasks. The accessories can be held by a dedicated accessory holder or support that is introduced into the surgical site through a separate opening. Alternatively, the accessories can be supported on the body of one of the surgical tools, and can be manipulated using another surgical tool in the surgical site. The surgical tools in the surgical site can use the accessories for performing a wide range of additional tasks without leaving the surgical site. In this way, the need to exchange tools and load instruments outside the surgical site is reduced, thereby minimizing xe2x80x9cdown timexe2x80x9d.
Some xe2x80x9cactivexe2x80x9d accessories need to be actuated to effect a predetermined treatment, such as an aortic punch, clamps, pliers, and the like. For such accessories, the actuation can conveniently be performed by an operator such as an assistant remotely from outside the patient""s body while placement of the accessories takes place in the surgical site by manipulating the accessories using robotic surgical tools in the site. A lockdown feature may be incorporated in accessories to lock them in place remotely from outside the surgical site upon actuation. An example involves locking clamp accessories in a closed position for clamping an aorta. After activating the lockdown feature, the assistant is freed to move on to the next task. In addition, the robotic surgical tool used to position the accessory may be removed after activation of the lockdown so that it is available to perform the next task. In this way, the robotic surgical tool inside the surgical site need only be used for a brief period of time to position the accessory and hold it in place until actuation and lockdown is performed remotely from the outside. This approach makes efficient use of the tools inside the surgical site and operator time.
In accordance with an aspect of the present invention, a method of performing minimally invasive robotic surgery in a body cavity of a patient includes introducing at least one surgical accessory and a robotic surgical tool into the cavity. The surgical accessory is coupled with the robotic surgical tool inside the cavity after separately introducing the surgical accessory and the robotic surgical tool into the cavity. The surgical accessory is actuated from outside the cavity of the patient to effect a predetermined treatment. The surgical accessory may be decoupled from the robotic surgical tool inside the cavity.
In some embodiments, the surgical accessory includes a movable member movable in the actuating step between a rest position and an actuated position. The movable member may be locked in the actuated position. In one embodiment, actuating the surgical accessory includes connecting the surgical accessory with a portion of the body cavity in the actuated position. Locking the movable member of the surgical accessory in the actuated position includes maintaining connection of the surgical accessory with the portion of the body cavity.
In another embodiment, two clamp accessories are introduced into the cavity. The clamp accessories are clenched around portions of an aorta with the clamp accessories in contact, desirably near the clamp tips, to enclose a region of the aorta, thereby partially occluding the aorta.
In accordance with another aspect of the invention, a method of performing minimally invasive robotic surgery in a body cavity of a patient comprises introducing at least one surgical accessory and a robotic surgical tool into the cavity. The surgical accessory is coupled with the robotic surgical tool inside the cavity after separately introducing the surgical accessory and the robotic surgical tool into the cavity. The robotic surgical tool is manipulated from outside the body cavity of the patient to position the surgical accessory within the body cavity. The surgical accessory is actuated from outside the body cavity of the patient to interact with a portion of the body cavity.
In accordance with another aspect of the invention, a robotic surgical system for effecting a predetermined treatment of a target tissue at an internal surgical site within a patient body comprises a surgical accessory adapted for effecting the treatment. An accessory introducer has a proximal end and a distal end with an opening therebetween. The distal end of the introducer is insertable into the patient body so that the opening defines a first minimally invasive aperture. The surgical accessory is coupled with the distal end of the introducer and passable through the opening to the internal surgical site. A robotic arm supports a surgical tool, and has an end effector suitable for insertion through a second minimally invasive aperture to the internal surgical site. The end effector is coupleable with the surgical accessory within the internal surgical site so that the robot arm can manipulate the surgical accessory to direct the surgical accessory to the target tissue. In specific embodiments, the accessory is actuatable from outside the internal surgical site to effect the treatment.
In some embodiments, the surgical accessory includes a proximal end disposed outside the internal surgical site, a distal end inside the internal surgical site, and a flexible body between the proximal end and the distal end. Examples of surgical accessories include an aortic punch, a pair of clamps, a heart stabilizer, a multi-fire clip applier, a pair of pliers, and a magnetic extractor.
In accordance with another aspect of the present invention, a robotic surgical system for effecting a predetermined treatment of a target tissue at an internal surgical site within a patient body comprises a surgical accessory adapted for effecting the treatment. The surgical accessory is configured for insertion through a first minimally invasive aperture to the internal surgical site. A robotic arm supports a surgical tool. The surgical tool has an end effector suitable for insertion through a second minimally invasive aperture to the internal surgical site. The end effector is coupleable with the surgical accessory within the internal surgical site so that the robot arm can manipulate the surgical accessory to direct the surgical accessory to the target tissue. An actuation member is configured to be inserted through a third minimally invasive aperture to the internal surgical site. The actuation member is coupleable with the surgical accessory within the internal surgical site for actuating the surgical accessory for effecting the treatment at the target tissue.
In specific embodiments, the actuation member includes a locking element for releasably locking the actuation member with the surgical accessory inside the internal surgical site. The locking element is manipulatable from outside the internal surgical site. The end effector is coupleable with the actuation member within the internal surgical site to manipulate the actuation member for coupling with the surgical accessory.